Dr. Dina Trevino PhD
Licensed Psychologist
7272 Wurzbach Suite 1504
San Antonio, Texas 78240
Office: 210-647-7712   Cell: 210-601-1478
General fax: 210-647-7805  Private fax: 210-568-4180
Accessing the Forms:  Some of these forms are in .pdf file format. In order to access these forms, you will need a recent version of the Adobe Acrobat Reader.  You may already have this program installed.  If not, you can download the latest version of the program here.  With the Acrobat Reader program installed, clicking on the form's link should display the form in a new browser window for you to print.
1. New Patient Forms
 
  • Functional Assessment Form
  • Statement of Understanding and Informed Consent -- Treatment
  • Statement of Understanding and Informed Consent -- Forensic
  • New Patient Intake Form
  • HIPAA Notice
  • Click here to acknowledge an electronic receipt via email that I have received and read the above HIPAA Notice.
    2. Consent Forms
     
  • NonParent Consent
  • Consent to Release/Obtain Information
  • Pre Authorization Credit Card
  • 3. Forensic Forms
     
  • Collateral Questionnaire
  • CPS Registry Check Form
  • Guidelines for Child Custody/Access Evaluations
  • Child Checklist of Charateristics
  • Family Information Questionnaire
  • Child History
  • 4. Clinical Documents

  • Attention Deficit Hyperactivity Disorder - NIMH
  • Loving and Caring Order
  • Cat Years
  • Divorce Rules - Termini
  • Childrens Bill of Rights
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